Mitral Valve Annuloplasty Does Not
Reduce Mortality in Patients with Mitral Regurgitation and Left Ventricular
Systolic Dysfunction

February 9, 2005

By Ashley
Starkweather, B.S. and Asher Kimchi M.D.

Ann Arbor, MI - In a retrospective
study of 419 patients between 1995 and 2002, mitral valve
annuloplasty (MVA) was shown to have no effect on the mortality
outcome of patients with mitral regurgitation and left
ventricular systolic dysfunction. The study, published by Audrey
H. Wu, M.D., M.P.H., et. al., from the Division of Cardiology at
the University of Michigan in the February 1, 2005 issue of the
Journal of the American College of Cardiology, was
designed to determine the effect of MVA on long-term mortality
in this sub-group of patients. While increased risk of mortality
was associated with coronary artery disease, increased BUN,
cancer, and digoxin, decreased risk of mortality was linked to
ACE inhibitors, beta-blockers, low mean arterial pressure and
decreased serum sodium. MVA did not predict clinical outcome.

In this patient population, mitral valve annuloplasty has been
shown to improve hemodynamics and symptoms, but its effect on
long term mortality is not clear. In order to assess the
relationship between risk of mortality and MVA in these
patients, the investigators retrospectively identified 682
consecutive patients who had significant mitral regurgitation
and left ventricle systolic dysfunction on echocardiography
between 1995 and 2002. Of these patients, 419 were identified as
surgical candidates, and 126 actually underwent MVA. The primary
endpoint of the study was patient mortality.

The primary endpoint was reached by 120 (41%) of the patients in
the non-MVA group, and by 62 (49%) of the patients who underwent
MVA. Increased risk of mortality was associated with coronary
artery disease, increased BUN, cancer, and digoxin. Decreased
risk of mortality was linked to ACE inhibitors, beta-blockers,
low mean arterial pressure and decreased serum sodium. MVA did
not have any significant association to mortality and therefore
was not useful as a clinical predictor of outcome.

In this study, there is no significant mortality benefit
conferred by MVA for significant mitral regurgitation with
severe left ventricle dysfunction. The authors suggest that a
prospective randomized control trial is warranted to further
investigate the association between mortality and MVA in this
patient population.